14+ units and counting

 It's hard to believe that amount of blood one has inside the body.... unit it starts to be expelled from the body.

I had a pt who had a GI bleed... and anyone in healthcare will know the smell that the breakdown of blood creates.... the smell of melena stool.

I was lucky enough that my pt was expelling things fast enough that it wasn't smelling like that. When I got the pt, he had had several procedures in an attempt to stop the bleeding internally. We thought it successful.... during my shift he only had two BMs - and it didn't have the clots and bulk that it did before. I thought I was pretty fortunate. I also thought the procedure successful.

Until the next shift when I ended up cleaning up six BMs. Again, no real melena smell. I figure where they thought that they had an issue and thought that they had fixed was what would stop the bleeding. Clearly though they did not... based on what the stool looked like, I imagine it to be small bowel, but close to the large bowel. Because it's not like it was bright frank blood but it was broken down some - but clearly it wasn't in his bowels long enough for the blood to be broken down to the point where the enzymes interacted with it and caused the typical melena smell.

Another scope another time. Hopefully this time it was successful.

For all the bleeding this poor soul has undertaken, he ended up with 14+ units of PRBCs.... his blood volume replaced twice+ over. Hard to believe, but hey, the human body is miraculous.

Full of bullshit

 We're almost at a point in our ICU that we can't accept any other patients. COVID's second wave is starting to take over our ICU. At last point we had 5 pts in our ICU and another 7 pts on the wards. And of course our numbers in the province are only getting larger not smaller so it's inevitable before we get inundated with COVID pts.

I previously asked our manager what the plan was for non-COVID ICU pts when our ICU is COVID pts - the powers that be indicated that they would cross that bridge when they come to it.

The last wave had some of our staff in the unit above with COVID ICU pts - a dangerous endeavor as the monitors for the pts were all inside the rooms, so it made it difficult to monitor pts accordingly. I'm sure they will be doing the same thing very soon.

Being that I have a workplace accommodation that I don't have to work with these pts, I've asked what they plan to do with ICU-trained staff who all have accommodations.... there's always going to be ICU pts that still need assistance.... until such a time when our hospital is overtaken with COVID pts. I'm sure that it will happen, look and see what's happening in the large cities in the US. Guaranteed that's what's going to happen here in Canada.

Hell, it happened with the first wave and everyone is saying that this wave is going to be worse. So I can't see us not getting hit this time around. We were actually quite fortunate that we weren't inundated with COVID pts the first wave. Sure we had our fair share, but at least it was manageable. I have no idea what they're going to do this time around.

I also think that the powers that be need to sort their shit out on who they provide resources to. I mean, intubating a 90yr old (IMO) is just a waste of resources when the second wave is just beginning. It's not likely that they're going to survive COVID, so why not just attempt to make their death as comfortable as can be?!

On to markings

 Received a pt a little bit ago, he had gone to our sister hospital for a cardiac catheterization.

They attempted to do a radial approach and was unsuccessful so they did the approach through the femoral artery. Now, one of the known complications is nicking the artery and causing bleeding. This poor soul was one of the unlucky few who experienced this and ended up with a retroperitoneal bleed - essentially, where they nicked had bled into his abdomen, creating a large blood clot when it stabilized.

It's obviously a medical emergency because your belly is a LARGE area and you can bleed into it quite quickly so the nurses that were there were laying all their body weight onto the poor gent in attempts to save his life.

Unfortunately, they didn't think it prudent enough to both to tell the poor gent that they were trying to save his life by doing just this. Now, do remember that this action is EXTREMELY painful to the pt. So of course this pt was fighting the poor nurses trying to save his life. I'm sure they could have saved some of the grief that they were receiving by just simply teaching the guy a few things!

So when I got him he was bruised, but not overly so. As soon as I received him on shift I examined his groin, how much bruising he had to the area and his abdomen for any subtle or blatant bruising, as well as his lower back because it can show up there as well. All things to keep an eye on. Stupid me though didn't mark the borders of his bruising (more on why that's important in a just a min) but just made a mental note of where and how much bruising was there in the area. I also checked out what was going on with his dressings to make sure that they were dry and intact, or whether there was any previous or active bleeding (femoral and radial areas). Both were as they should be, clean, dry and intact.

So off my pt goes to sleepy town and in the morning when I wake him for blood work, he tells me that his belly really hurts. I asked him if he needed to void, he told me no but I told him that he needed to attempt to void anyways. So off he goes, does just that and questions why he had to pee so much when he didn't feel the urge to go. So some education time later, I told him I needed to see his nether region to check out the bruising and whether there was any swelling. One of my red flags went up because I noted that his mons pubis (where all your hair is above you lady/gent bits) was more swollen than at the start of the shift and another flag went up when I saw that his bruising had extended in towards his mister bits. 

I asked if his pain had changed since voiding, thankfully he indicated that it had lessened but was still present. I went an looked to see whether my CBC was back and examine what his Hgb (red blood cells) were and how much things had changed.

From my pt returning and having his Hgb checked at ~1000hrs it was 127 then at 1600hrs it was 121 but when I got the result at 0600hrs it was 108 - so in almost 24hrs it had dropped 19points - significant! 

Off I went to tell my charge nurse all this and ensure that i was doing the right thing by getting a hold of the physician... she agreed and off I went to call him.

I advised the Dr of all of the above and asked what they wanted done.... I got complete silence. I understood that I likely woke the Dr up but still expected something more. So I asked whether he wanted me to just monitor it or do something more extensive. I was told to monitor it. I asked how normal the spreading of the bruising was... I was told that gravity would naturally spread the bruising down the leg and into the groin and nether bits, but that marking is prudent. I advised that I had done this prior to calling. Then I got silence again. I was expecting more from this Dr, some sort of direction to take. I asked if he wanted me to repeat the CBC, say like 6hrs later.... I got a "ya, sure". Ok, I guess I'll take it. The good thing was that at least I could document it all. I did my part in all this.

Marking my pt was quite interesting, having to get down and dirty really.... getting handsy with his bits and pieces so that I could mark where the boundaries of the bruising were. He was a sport though and took it all in stride.... "oh I wish this could have happened when I was a 19 yr old!" HA! 

Unfortunately, when I came back 12 hrs later, he was transferred out to give the bed to someone who was sicker so I don't have any notion as to how things ended. wahwahwah. C'est la vie, such is the life of a ER/ICU nurse.... we don't always get to know the outcome of our pts after they head out of our area.

COVID baloney

 Friggin Covid. I'm sure there's a consensus that it sucks. For me personally, I haven't had to have much to deal with this on a patient level. When we started to get COVID pt's in our ICU, I got a workplace accomodation as I have a IgG deficiency and I also take Humira which further decreases my immunity levels. My IgG deficiency tends to affect my lungs in particular and so I had a conversation with my MD about the accomodation to not have any suspected, presumptive or confirmed cases of COVID. The notion is is that if I were to contract it, that I would be one of the unfortunate few who would require ICU admittance and probably be intubated. So to protect me, I got it done. Paperwork was sent off to Oc Health and it was granted.

Then when they were reevaluating the accommodation status of everyone in the hospital, mine was as well. I explained to them why I needed the accommodation and what not and they told me that they would speak to the Oc Health Dr and get back to me. They did, and I was told that the Dr had advised that I be redeployed permanently out of bedside nursing!!! I told them that I appreciated that they care enough to recommend that but that I was kindly declining that. I told them that I had mitigated my risk by leaving ER and moving to ICU... that in the ICU I am generally 1:1 or 1:2, unlike in the ER when you could be up to 1:5/6.... and when the pt finally gets to ICU, we generally have an idea of what they have and there are generally treatments available for whatever ails them and so IF I were to catch whatever a patient has, there is the treatment available. And if there redeployed me elsewhere, med-surg is generally 1:4 and up to 1:8.... and if they put me in a clinic I could be exposed to as many people as 100 per day.... so obviously the risk is smaller in the ICU when I'm only going to be exposed to as many as 2 ppl. 

When I explained it that way they responded that I had clearly given this some thought.... of course, it is my health and life we're talking about!

So I've been trudging along in the ICU, not having to care for COVID pts when an unexpected thing happened...

I had gotten my hot drink from the coffee place in our hospital and was walking to my unit and somehow pinched a nerve in my neck. Holy crap was it painful! So I was on modified for a bit and when our area of the world opened up a bit and I could go see a chiropractor and he put me on further modified duties and so I was taken out of ICU because they couldn't accommodate my restrictions.... no bending/twisting, no lifting over 10 lbs, no raising my arms above my shoulders and no pushing or pulling. He figured that I was compensating for my neck with my lower back. So then I became a COVID screener and have been there since, goodness I miss being a nurse!

Well then one particular day I had a particularly busy shift and when I went to the chiropractor and did an adjustment on my back, a very minor one on my lower back in particular, I couldn't put any pressure on my lower back, I had crazy pain travelling down both of my legs and I couldn't stand up. The chiropractor gave me some numbing cream to put on the area and in about 20 min I was finally able to stand, but lifting my feet was still an issue and it still hurt to do so. These symptoms got better with time thankfully but the chiropractor thinks there's something structurally wrong with my lower back and stated that I need a MRI to figure out what's going on and that I shouldn't go back to full duties until I get this done. Not that hubby agrees with this. He wants me back in the ICU ASAP, be damned if I get hurt again or more.

So for the time being I screen ppl for COVID symptoms as they're coming into the ICU... behind glass and in proper PPE. I hate it, but it's an easy job for sure. We'll see where this takes me.

WTF OR?!

To hand someone over that is basically dead and say that they are only hemodynamically unstable in not OK.

We knew that we were getting a patient who went from our sister hospital's ER and transferred to our hospital's OR for emergent surgery. We were told that this person required massive blood transfusions - weren't told what they received but that the code for the massive blood transfusions was cancelled - making us believe that the person we were getting was stabilized. I told everyone that it was going to be a "gong show".

We tried to look up in the system something about this person because all we knew was that they were really young and they had an inferior vena cava filter and that it had eroded there and the pt was bleeding. We knew that clearly this person had other shit going on if they were that young and required this. The crazy thing is that the chart had NO information from doctors from the last four days worth of ER visits! No information listed to blood work that was done over the last couple of days. How in the world could this person not have ANY blood work any of the previous days considering they were on blood thinners and had this filter in place. You would think that they would do blood work (BW) - such a basic thing. On the fourth day they finally did and their INR was 12!!!!! Oh, and their Hgb was 30!!! Shame on the ER for not doing BW on any of the other days, they for sure would have caught things declining a whole lot sooner.

I was the assist nurse that shift, helping those who received admissions. The nurse had indicated that they hadn't done an admission yet - surprising cuz this person had been there longer than I. So I advised them that when the OR called to ensure that a proper report was given because often they will just tell us that they are coming and asking whether we're ready. So I told her to make sure that she found out what state that this person was in. I advised her to find out what meds that this person was on because I absolutely believed that this patient would be on meds to support their BP, guaranteed and you don't want to be chasing your tail when they arrive, trying to get these meds infusing while trying to settle your patient. For some unknown reason the pumps they use in the OR is different than the ones used in the rest of the hospital. Therefore it was pertinent to find out the meds they were on so that they could be ready to change over to our system. Of course I was right when they called and advised that they would be coming in 10-15 min and then subsequently hung up. The nurse, listening to me, called them back and received a proper report.

When the OR people brought the patient to us the lines were a mess! While myself and another nurse were getting things sorted out and attached to our cardiac monitor, I pulled all the blankets off and saw that they had two intraosseus (IO) and several peripheral IV lines and then a single lumen central line (SLIC) - and they had pressors running but no blood or even IV fluid. The pt also had a art line showing their BP and when attached to our monitoring system we could see immediately that the art line BP was seriously low => something in the area of 50/25.... not enough to sustain life for sure. And the nurse asked the anethetist WTF and was told that the art line wasn't accurate so a BP cuff is quickly put on and the BP was basically unchanged - so immediately the ICU Dr asks for a pulse check.... nope, no pulse and so we immediately start coding this pt.

We restarted the massive transfusion protocol and start pumping fluids in, hoping that we can revive this person. Sadly we coded this person for quite a long time and couldn't get them back.

Now I'm left with the feelings of this whole situation. I don't understand why the OR would cancel the transfusion code... did they even check pulses before sending us this person. Were they just trying to offload this person on the ICU so that they could be relieved of the fact that this person did NOT die in the OR?!

We had a debrief after TOD was called. We talked through this all. We talked about how hard it was for information to be found about this person's current medical condition and any recent blood work. We couldn't understand how the OR did NO blood work while the patient was in the OR. Why would they cancel the transfusion protocol if they had no numbers to back up cancelling it. They had NO idea what this patient's Hgb/Hct was when they brought them to us in the ICU.

ICU didn't stand a chance of saving this person because so many people before us failed this person. To learn that this person just celebrated their birthday and then to learn that they were a refugee made this death even worse. Such a short life to be cut short when so many other steps could have been taken to save this person.

Ouch

We have a coffee shop in our hospital and several weeks back I picked up my tea and headed to my unit. But on the way up I managed to hurt my neck. Couldn't tell you how.

I went home that day, goodness the pain was intense. But it gradually eased up and I went back to work after a bunch of days off. I got lucky that I had cardiac patients and it wasn't hard on my neck and got through my couple of shifts. 

This last week however, I had a typical ICU patient and managed to tweak my neck again. Goodness it hurts. I get this shocking pain down my neck, through my shoulder and down into my fingers. I know I pinched a nerve at about C6-ish. Confirmed by the ER MD. No test though, so don't really know why exactly it happened.

Regardless, I lost another day of work and had a couple more days off afterwards so I rested as much as I could - doing my physio to help myself.

But to no avail, still hurts like a mother sucker - so I let my family MD know about it and so now I'm on modified duties. Also, I need to have physio and a chiropractor would be helpful, but can't because everything is still shut down. Sad face!

Had to work last night, thankfully we had an ICU patient that didn't require any pushing/pulling,turning/lifting - a nice stable DKA for me thank you very much.

Even having a pt like this caused pain - but at least it was manageable. We'll see what this weekend holds as it's my weekend to work. So this should be interesting to say the least.

Wish me a speedy recovery.

When the will is overrun by family decisions

How does it come to be that families can make the decisions for family members in critical care, when they themselves have made it known what they would choose for their life and their death?!

When someone comes in for a fairly basic surgery (albeit an emergent one) and have a perioperative MI and when they are woken are told what has occured and that they require a cardiac catheterization - to which they decide that they would prefer to not undertake this.

The surgeon (or whoever it actually was - a MD none the less) had a frank conversation with said patient and indicated that the catheterization wasn't performed, that a major heart attack would occur.

The patient, in right mind, made the decision that they would not have this procedure performed, even if that meant that they would have a heart attack.

Then advised that they could die if this occurs, the patient indicated that that was alright and that should a heart attack occur, no CPR/defib or intubation occur. Meaning that nothing should be undertaken if a heart attack is to occur and survival not be possible.

Now the twist in this entire story is the fact that the health care person who had this conversation, and could write it down and make it official, DIDN'T WRITE AN ORDER!!! All they did was put it in their notes. Friggin idiot!

So of course this person had a massive heart attack and went into an unsurvivable cardiac rhythm (VF to VT) and they called a code and managed to get this person back.

Then of course it's family who decides what the next steps will be. Even though the family find out what the patient said to the MD, they still decide to do everything in our power to get this person through this.

Now after some time has passed, this person is basicly a vegetable - doing very little more than lying in bed and existing.

I feel for this patient - ending up in this state after indicating exactly what they don't want and because of an oversight, ended up having everything done they didn't want. Now they have to live with the consequences of this and what their family is choosing for them.

If I were them, I'd come back and haunt my family after I actually get to die. That's the least that they deserve for making me suffer as a vegetable in bed. Such a pity of a life. No quality at all.

Heart to heart

As I've indicated, I work in a combined CCU/ICU and so there are times when I have to take care of people who have heart issues as their main issue. That's what I got to take care of one shift, I started out with a completely different assignment but because of my workplace accomodation, didn't have to remain on that assignment and was traded for someone else's. I ended up with a little old lady (LOL), a 96 yr old gal who had a NSTEMI - perfectly stable thankfully. More of a watch and see. She just wanted to be medically managed and be made better. That's what she got in the end.

My other bed was empty at the beginning of the shift but I was told that I would be getting a new admit from the ER. Another NSTEMI but with an extensive cardiac history and was on chemo for some kind of cancer that metasticized elsewhere. Never a good thing. Chemo is HARD on the body I say, and of course that also takes a toll on the heart.

He was a sweet old sole. When I first met him, in the first 10 minutes became significantly unstable. I spent my entire shift on the phone calling the most responsible physician (MRP) for orders or follow up - this that and the other thing. I felt like I was calling them constantly. All for good reasons too. Turns out that ER didn't bother to tell me that this fellow had an inferior MI and the good ER docs went and ordered Nitro and morphine for my fellow. Now this is VITAL information for a person who is to take care of ppl like these. Shame on me for not asking really. I figured this type of info a person would readily share with someone else. But nope....

When I got report from the ER nurse I was advised that she had given Nitro and my fellow's chest pain (CP) had been relieved with this. So when he came to me complaining of CP again, I went and did what my previous counterpart did and give Nitro. Well if I had been told about the inferior bit I certainly wouldn't have done this! It did as expected and relieved his CP but also sent him into cardiogenic shock. So I spent the rest of my shift trying to keep him alive because of the unintended consequence of this action.

What should have happened was that they should have taken him straight to our sister hospital and figured out his heart issues and tried to help him. But they said no so we had to hold on to him until morning when the cardiologist could force sister hospital to take him. Which  happened and so I started shift two with him post transfer from sister hospital - being told that his 5 vessel CABG done almost 20 yrs ago had basically all clotted off and his heart was pooched. There wasn't anything they could do and stopped their PCI and sent him back to us.

So sad to come on shift to a sweet fellow and hear that there wasn't anything they could do for him. Kick in the pants I tell ya. So I went in to my patient, and had a frank heart to heart with him about what HE wanted. I asked him if the guys at the sister hospital had told him what they found, they did thankfully and so I asked him what he wanted out of all this. He understood that his life was in jeopardy, even if he did survive this current event. He told me that he just wanted to spend more time with his family. He was a father of three and still married. He indicated that if he could just get another month or two, that was all he wanted.

So I spent the rest of my shift, trying to make him comfortable and trying to prolong his life as best we could. I made it to the end of my shift and when I came back on he was still in my CCU. So another shift was started together.

I started this new shift in good spirits, he was requiring less heart support than when I had left and things were looking up. During the day shift I guess the Docs had a good discussion with him, after I had laid some seeds about CPR and intubation - that would he really want to pass with us pounding on an already impaired heart? That it wouldn't be a good death and he would still end up dying likely. So I was happy to see that post discussion with the Docs that he had decided a NO CPR/Dfib/Intubation for his care. I think he made the right decision, certainly for him anyways.

In the middle of the night things turned south though. Of course it all happened just as I was coming back from break He began to have ischemic events and his heart rhythm changed as did his BP - requiring more support to support it.  I called the MRP and advised them and they came to assess him. I started him again on an antirhythmic and bolused him twice, hoping that he would convert. We kept at it for several hours and he did come out of the atrial flutter into atrial fibrilation but not for long unfortunately. I let the MRP know of this and she indicated that she would have to come perform a cardioversion. I let her know that I wasn't sure his heart would survive it, given that he's so clotted everywhere and he's having ischemic events right now and going into poor rhythms - ones that really are unsustainable.

So we decided together that we would call in his family and let them be together. I had to seek out approval for this because of the pandemic and no visitors are allowed unless death is expected. And although my fellow wasn't actively dying it wasn't expected that he would survive. And who knew if he even could survive with or without the cardioversion.

I had a frank conversation with my patient again about the impact of cardioversion - how it hurts like hell (don't know it personally but professionally) and we don't even know if it will improve his chances of survival. So he asked if he could speak with the MRP to ask this. Shockingly the MRP put this task onto another Doc - saying that it should be the cardiologist who has this conversation with him. But of course I find out after the fact that the MRP who said this IS a cardiologist herself!!!! That's what happens when you're too new and don't know everyone! So when I left my final rotation shift, my patient was still on the antirhythmic and requiring a cardioversion but wanting to speak with the Dr.

I came back several days to find out that when the Docs did go and talk to him he decided to not take the cardioversion and decided that he would live out his final days with his family surrounding him. I found out that this, however, took several days to come to fruit because palliative care Docs wouldn't take responsibility until pushed to.

But at least he got to palliative care and can spend the rest of his days surrounded by his family - the way he wanted it.

How the times have changed

So I know that my last update was like 3 years ago. Feels like the time has flown. I really thought that I was going to keep up with the blog but that fell to the wayside when my life kept taking turn after turn.

I was kindly "advised that NICU isn't the place for me to do nursing" - all because my cares on teeny tiny babies was too slow. Sheesh I was learning. It's not like I did any placements in NICU but I was expected to know how to make such tiny babies eat and be fast when changing their diapers or changing their linens.

So I essentially gave up on my dream - I gave it a shot at least and came back to my family. We spent some time figuring things out. I had to work for an agency and do part time work as a RPN/LPN until my NNAS (National Nurses Assessment Service) - for them to determine whether my education and experience is enough to receive equivalency for the college in my province to give me the ability to practice as a RN. That process took about 9 months and thank the Lord that I did (I'm pretty darn lucky as far as I've heard).

Then I started working in an ER (third busiest in my province) while I was taking MORE education - my critical care certificate (CCC)... so that I would be more prepared for what I would see in the ER or IF I wanted to move to the ICU, that I would be prepared for that as well. I was planning to stay in the ER but was getting screwed over where I was. They were promoting people to the more serious area before me - ones who had less nursing experience, were in the ER less time than me and didn't have the CCC - hell one of them didn't even have cardiac care 1 - which would mean that these people would at least have the knowledge, skill and judgement to take care of people who are under continuous cardiac monitoring. So I cut out of there and started applying to hospitals in the area in which I live. I got several job interviews and in the end, got a job offer during one of the interviews in fact! I ended up taking the ICU job - started that in January.

So I've been learning a TON working in the ICU with adults. It really is a different can of worms than working with babies in the NICU. I'm enjoying it for the most part. Until COVID hit that is.

I can't really remember how much I've said about my immunity issues (I think I've talked about it all) - but long story short - I have immunity issues. I have IgG deficiencies and I'm also taking Humira for an autoimmune condition (Hidrdinitis Supprativa - AKA Acne Inversa) - and we know that my immune system isn't the best at the best of times (though I have been lucky that I've been pretty healthy lately). So when COVID hit I requested that I not have to take any of these patients. I had a couple of good charge nurses who were alright with it until there was one that threw a fit and then I had to take it to the manager and start the official steps. So then I contacted occupational health (with whom I had sent all my health documentation to about my immune system issues) and asked them for a workplace accommodation. Of course they were giving me issues and so I took this information to my physician and asked for a letter to give them. Thankfully he did, mainly because he agreed that if I did get one of these patients and I contracted COVID, that I would likely end up on a ventilator. So once I handed in the documentation I finally got the workplace accommodation to not take any COVID suspected, presumptive or confirmed cases.

Of course there are some people, including my  manager who question why I even work in the ICU if I have such a compromised immune system. Which I mean, I get. But the thing is is that the vast majority of people that we take care of in the ICU have treatments available that I could receive IF I were to catch anything that they have. Unfortunately, at this time the same can't be said about COVID at this point in time.  I mean, even if we were to get inundated with COVID patients, there are always going to be ICU patients, or CCU patients (ours is a combined unit).  I've convinced a lot of people with this next argument - wouldn't you rather me take care of ICU patients while you take care of COVID patients (or other ICU patients), meaning that we're both on a 1:1 - instead of me working elsewhere and then that potentially means that you would be doubled with an ICU patient. Of course when people hear this aspect, they always agree and drop the argument. So I haven't been reassigned elsewhere. To which I am quite thankful for. I didn't start working in ICU to be reassigned elsewhere.

As all this is occuring, I'm trying to convince hubby to FINALLY have another baby. He keeps saying "soon" - but 11yrs have come and gone with him constantly saying "soon". This has made me quite upset with him cuz I've given him 10+ yrs to get on with the soon bit. He kept saying that I had to do this task or meet this provision - all of which I did. But alas, he still says "soon". Now he wants me to do my critical care certification - and my nurse practitioner (NP) but I've told him I won't do any of it until such a time that I am pregnant with our next bambino/ini. He tells me that because he is accepted into a training opportunity (he doesn't want me putting it out into the world where he's been accepted because he hasn't yet gone for training) he doesn't want me to be pregnant while he is away. Also, he wants to be secured in knowing that he will succeed at training and will go forward to be placed that then he'd be willing to have more children. And of course because of this damn COVID pandemic, his training got cancelled until who knows when. I just don't know if he understands how difficult it may make becoming pregnant the longer he keeps putting this off. He thinks that once and done. I'm no longer young - it may take some time and much practice to be pregnant again. Also, it hurts my feelings (not that I think he cares much of that) that he continues to put this off.

Throughout the years I have willingly put off having more babies because it was in our best interests to put it off. It would have been more difficult because we didn't have the space for more kiddos, and it would have made getting my education completed more difficult as well. Hell it was hard enough having one little one, let alone more. Though I have learned that I can muster through my education regardless of having littles running around.

I have sacrificed a TON being married to my hubby. I moved because he hated the city we were in. I have lived in a tiny house, in the basement for MANY years. I have suffered being under the same house as his family - with frequent fighting. I have put off having more children because hubby deems it so. At what point does he start giving me what I need? What he agreed to when we got married. It's not like we're hurting financially either. He told me just this past year that if I saved up like $6000 that he would agree to more - well I've certainly done that, and more! And yet he still says the same damn thing - SOON. God I hate that word. It certainly doesn't denote the same meaning it once did. But I don't know how to convince him to just say yes, now we can.

UGGGGGHHHHHHH - I just want to scream at him.

Honestly I told him that I would leave him on my bday - it happens next month. I will though, if that's what it takes for him to finally relent. I hate that it would have to come to that. But clearly his priorities for our family aren't the same as mine. I'm done putting this off. I don't want to take any longer than this has already. It's a shame that he'll have to choose between having me and having more babies or losing me because he doesn't want any more babies. Stupid that he's acting that way, also that I have to make this decision. But I will if I have to. I thought we were aligned in the important aspects, but this is clearly one major area that we don't - or do we?